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, <br /> SWRCB,January 2006 <br /> Spill Bucket Testi?g Re rt For <br /> This form is intended for use by contractors performing annual testing ofUSTspilt containment structures. The completed form and printouts from <br /> tests(ifapplfcab/e),should be provrided to the faolfrty owner/opmtorfor submittal to the kcal regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: Shell Date of Testing: 4/2$/2017 <br /> Facility Address: 717 W. Eighth Street Stockton <br /> Facility Contact: Joe Dan Tran Phone: 209-9 961 <br /> Name of Local Agency Inspector(Kpmsent during tes&W.. <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Pinnacle Fuel Compliance Services,Inc. <br /> Technician Conducting Test: Aneil Chand <br /> Credentials': ®CSLB Contractor 9 ICC Service Tech. 0 SWRCB Tank Tester 00ther(Specify) <br /> License Number(s): ICC#5119959-UT S RC 1262 CSLB#894932 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ®Hydrostatic ®Vacuum 00ther <br /> Test Equipment Used: Tape measure,stop watch Equipment Resolution: 1/16" <br /> Identify Spill Bucket(By Tank Regular FIII <br /> Number Mored Product etc. <br /> Bucket Installation Type: Sump <br /> Direct Bu /Sum <br /> Bucket Diameter: 12 <br /> Bucket Depth: 14 <br /> Wait time between applying 15 <br /> vacuum/water and start oft t: <br /> Test Start Time(Ti): 60mins 13:30 <br /> Initial Reading(RI): 9. <br /> Test End Time(TF): 0 mins 14:30 <br /> Final Reading(RF): 9" <br /> Test Duration(TF-TI): 60 mins <br /> Change in Reading(RF-RI): 0 <br /> Pass/Fail Threshold or Criteria: 1/16-60 <br /> Test Result: Pass/Fall PASS <br /> Comments- !?dude infomravon onjqpqire made to testfn,and recommended two-u forfa/fed tests) <br /> 1' <br /> ,_UI N ZUK <br /> ENVIRONMENTAL HEALTH <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTI <br /> /hweby certify that a#ft inkmadon contained In Ods ieport Is In fuN wmpNance mal mqukww1& <br /> Technician's Signature: Date: 4 017 <br /> State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements may be more <br /> stringent <br />